Provider Demographics
NPI:1508600594
Name:HENNEBURY, MAEVE KATHERINE (RN)
Entity type:Individual
Prefix:
First Name:MAEVE
Middle Name:KATHERINE
Last Name:HENNEBURY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MAEVE
Other - Middle Name:KATHERINE
Other - Last Name:GABOLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:78 QUEEN ANNE CT APT 26
Mailing Address - Street 2:
Mailing Address - City:EAST WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-2822
Mailing Address - Country:US
Mailing Address - Phone:339-788-1656
Mailing Address - Fax:
Practice Address - Street 1:235 WELLESLEY ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1572
Practice Address - Country:US
Practice Address - Phone:339-788-1656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2355659163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health